1. Fracture prevention pathway in South Central Proposed patient pathway Bone treatment pathway Administration pathway

2. 400 500 560 610 175 360 600 380 160 140 375 4260 hip fractures ~12,800 non-hip fragility fractures Current status: How many fractures?

3. After the first fracture, act to prevent the second Fracture prevention is cost releasing

4. Inpatient only 50% only Inpatient only No Inpatient only No No 100% provision of fracture Prevention services in SC Current status: How many fracture prevention services?

5. “After the first fracture, act to prevent the second... anywhere within South Central ” Coordinated Implementation Equitable Effective Evidence based

6. Community clinics: FPN + GPSi Risk factors: bone + mini Falls Bloods Rx Monitoring for 5 years: Adherence Side effects / Re # OUTPATIENT FRACTURE CLINIC TRAUMA Secondary care Non- surgical (pelvic/ T/L #) NOFNon NOF Admitted non-trauma Community bed/ Care home DXA appropriate? NO ASSESS Bone/ mini-Falls TREAT/ REFER YES DXA + falls triage REFERRAL

7. Strategic Critical Success factors To make savings in medium to long term, across the total health and social care pathway through reduction in re-admissions from recurrent fracture and falls. To improve the quality of the experience for the individual and their family, by developing equality of access to information and management of all fragility fractures To support best practice in the care of people who have fragility fractured

8. Range of Targets To reduce by 30% reduction in the re-current all fracture rate To reduce by 50% the re-current hip fracture rate To reduce by 50% the re-current fall rate To reduce by 10% all fractures in the over 65 population from the predicted population growth (local target in place since April 2009) A 20% reduction in non-conveyed falls seen by the ambulance service in patients with a previous history of fracture Corresponding reduction in care home placements and in domiciliary packages Reduction of patients referred to Nuffield Orthopaedic Centre, Metabolic Bone clinic and CHO Falls clinic To improve case finding of fragility fracture patients presenting to acute care. To increase the percentage of fragility fracture patients receiving falls and bone health assessment (questionnaire, bloods, DXA) All individuals with a fragility fracture are put on to an individual management plan

9. The next step This is a big change in practice 2 pilots for specific aspects of case finding, falls and bone assessment at JR Trauma OPD by both falls and bone health staff Test before commissioning more widely Propose a 6 month feasibility study – 2.0 Nurses – 0.5 Admin – Prototype database – Clear productivity, cost and quality outcome metrics…..to justify full commissioning across the region